Provider Demographics
NPI:1467505529
Name:CENTRO DENTAL FAMILIAR PC.
Entity Type:Organization
Organization Name:CENTRO DENTAL FAMILIAR PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:FILION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-424-5559
Mailing Address - Street 1:37 42 90 STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-424-5559
Mailing Address - Fax:718-426-2484
Practice Address - Street 1:37 42 90 STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-424-5559
Practice Address - Fax:718-426-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02849003Medicaid